Unit 5: Ostomy care and management

Stoma

A temporary or permanent artificial opening in the abdominal wall due to certain diseases that prevent the normal passage of feces through the rectum.

Ileostomy

a surgical opening in the ileum. It bypasses the large intestine. As a result, stools are frequent and solid.

Colostomy

a surgical opening in the colon

NSWOC

a nurse specialized in wound, ostomy, and continence management

Colostomy of the ascending colon

Stools are frequent and solid

Colostomy of the transverse colon

In general, it results in a more solid, formed stool.

Descending and Sigmoid colostomy

emit a near-normal stool

Loop colostomy

is usually performed in a medical emergency when closure of the colostomy is anticipated. They are usually temporary large stomas constructed in the transverse colon. The surgeon pulls a loop of bowel onto the abdomen. It has two openings through one stoma. The proximal end drains stool, whereas the distal end drains mucous.

End colostomy

consists of one stoma formed from one end of the bowel with the distal portion of the GI tract either removed or sewn closed and left in the abdominal cavity. For many patients, this is a surgical treatment for colorectal cancer. In such cases, the rectum might also be removed. Patients with diverticulitis often have temporary ___ colostomies.

Double-barrel colostomy

the bowel is surgically severed and the two ends are brought out onto the abdomen. It consists of two distinct stomas: the proximal functioning stoma and the distal nonfunctioning stoma.

Kock continent ileostomy

is created using the patient’s small intestine to create a pouch. This procedure is occasionally used in treatment for ulcerative colitis. The pouch has a continent stoma, which is a nipple-type valve drained with an external catheter intermittently in the stoma and empties in the pouch several times a day, The stoma is covered with a protective dressing or stoma cap.

Colostomy irrigation

one of the management options for the person with a sigmoid or descending colostomy. Some patients may be instructed to irrigate their left-sided colostomies in order to regulate colon emptying. An enema set should never be used. A special coned tip irrigator is used. This device prevents both the backflow of the irrigating solution and bowel penetration. For adults, 500-700mL of tap water. It should take up to 5-10 mins. The patient then removes the cone tip and waits 30-45 mins.

Pouching

consists of a pouch and a skin barrier. They come in one- and two-piece systems that are disposable or reusable. Some have the opening precut by the manufacturer; others require the stoma opening to be custom cut to the patient’s specific stoma size.

One-piece pouch system

Wafer skin barriers that are permanently attached to the ostomy pouch

Two-piece pouching system

the pouch can be detached from the skin barrier for emptying or changing. This system allows the skin barrier to remain around the patient’s stoma for several days, thus minimizing the chance of skin damage from too-frequent removal of the skin barrier from the peristomal skin.

Wafer Sizing

• After cleaning peristomal skin and pat dry, measure the stoma

• Trace pattern of stoma measurement on pouch backing or skin barrier

• Cut opening on backing or skin barrier wafer

• Remove protective backing from adhesive backing or wafer

• Apply pouch over stoma. Press firmly into place around stoma and outside edges. Have patient hold their hand over the pouch to apply heat to secure seal.

• Close end of pouch with clip or integrated closure.

Initial diet

Low-fiber diet recommended post-surgery, especially for ileostomy patients, to allow bowel adaptation.

Long-term diet

Most foods can be reintroduced as the ostomy heals.

Urinary Diversion

a urinary stoma to divert the flow of urine from the kidneys directly to the abdominal surface. It can be created for several reasons, including bladder cancer, trauma, radiation injury, fistulas, chronic cystitis. It may be temporary or permanent.

ileal conduit

involves separating the loop of intestinal ileum with its blood supply intact. The ureters are implanted into the isolated segment of the ileum, with the remaining ileum reconnected. The isolated ileal segment can then be used as a conduit for continuous urine drainage.

Orthotopic Neobladder

is an internal pouch created with the ileum and is reconnected to the urethra. Patients will void via the urethra but may need intermittent catheterization.

Indiana pouch

is a continent internal pouch created from the ileum. A portion of the pouch is connected to the abdominal wall and acts as a continent nipple, and intermittent catheterization is needed for emptying.

Ureterostomy

although rarely done, involves bringing the end of one or both ureters to the abdominal surface

Nephrostomy

this procedure involves inserting a tube directly into the renal pelvis to provide urinary drainange.